In response to PAR-08-153 ("Collaborative HIV/AIDS Studies in the Middle East"), the Center for AIDS Intervention Research (CAIR)//Medical College of Wisconsin-- in collaboration with the Center for Community Health (CCH)/University of Memphis and the Syrian Center for Tobacco Studies (SCTS)-- requests 2 years of funding to collect phase 1 formative data about HIV risk behavior among multiple at-risk groups in Syria, including people living with HIV, people seeking STI-related services, commercial sex workers, men who have sex with men, and injection drug users. Data will be used to inform development of culturally-relevant HIV/STI risk reduction interventions for at-risk groups in Syria that can be evaluated in subsequent studies. We also will use think-aloud methods to refine an A-CASI risk behavior survey that will be necessary to evaluate intervention effectiveness in future studies. Toward this end, and in response to PAR-08-153, our proposed study has three primary aims. (1) To identify HIV/STI risk and preventive behaviors, mediators, and moderators that will need to be addressed in a subsequent prevention intervention aimed at groups at high-risk for HIV/STI infection and transmission, including people living with HIV, people seeking STI-related services, female commercial sex workers, men who have sex with men, and injection drug users. (2)To document the feasibility of strategies to access and enroll these groups at high-risk for HIV/STI transmission and infection into a prevention intervention study. (3) To tailor and refine the wording and content of a quantitative risk behavior survey that can be used to evaluate a future HIV/STI prevention intervention trial that based on the lessons learned from this formative study. Our research design and assessment measures will be developed in close consultation with a Community Advisory Board, comprised of influential Religious Scholars and key health delivery and public health stakeholders in Syria. The support of local Religious Scholars and health care delivery systems will enhance our capacity to successfully implement evidence-based public health HIV/STI risk reduction intervention programs. Further, researchers from CAIR and CCH will work closely with researchers at SCTS in Syria to develop local HIV research infrastructure, capacity, and expertise. CAIR researchers have a long history of building local research capacity in non-U.S. countries. Likewise, researchers at CCH and SCTS have developed a very successful health behavior and epidemiological research infrastructure in Syria which has trained many local scientists and won several international awards. The Syrian Project Coordinator is the former Director of HIV Prevention Services for the Syrian Health Ministry. The respective strengths of the collective research teams provide a strong foundation to successfully develop and implement a culturally- competent program of HIV/STI prevention intervention in a low prevalence country before a rapid disease outbreak occurs. Such preemptive efforts are needed to stem the continued global expansion of HIV/STIs, especially in Islamic-Arab countries of the Middle East. Findings from our study will be disseminated for use in the development of HIV/STI risk reduction interventions in Syria, as well as the broader Middle East region given the many sociocultural similarities between Syria and other Arab-Islamic countries in this region. PUBLIC HEALTH RELEVANCE: The development and conduct of a program of culturally-competent HIV/STI prevention intervention research in a low prevalence country can preemptively stem the potential of a rapid outbreak of HIV/STIs. Such preemptive efforts are needed to stem the continued global expansion of HIV/STIs, especially in Islamic- Arab countries of the Middle East-North Africa (MENA) region. Findings from our study will be disseminated for use in the development of HIV/STI risk reduction interventions in Syria, as well as the broader MENA region.